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# Tabvoihep (Hepatitis B Immune Globulin)
## Overview
Hepatitis B Immune Globulin (HBIG) is a sterile solution of immunoglobulin G (IgG) containing antibodies to the hepatitis B surface antigen (anti-HBs). It provides passive immunity against hepatitis B virus (HBV) infection.
## Primary Indications
* **Post-exposure prophylaxis:** To prevent hepatitis B infection following exposure to the hepatitis B virus (HBV). This includes percutaneous or permucosal exposure in individuals not previously vaccinated or with an inadequate response to vaccination.
* **Infants born to HBsAg-positive mothers:** To prevent perinatal transmission of HBV.
* **Post-transfusion hepatitis B:** In cases of significant HBV exposure from transfused blood products.
## Adult Dosing
* **Post-exposure prophylaxis (percutaneous exposure):** 0.06 mL/kg IM as a single dose. Administer as soon as possible, preferably within 12 hours of exposure.
* **Post-exposure prophylaxis (sexual or perinatal exposure):** 0.06 mL/kg IM as a single dose. Administer as soon as possible, preferably within 14 days of sexual exposure or within 12 hours of birth for infants.
* **HBsAg-positive liver transplant recipients:** Dosing varies and is often guided by transplant center protocol, typically involving monthly administration.
*Maximum dose is generally not specified, but calculated based on weight.*
## Pediatric Dosing
* **Infants born to HBsAg-positive mothers:** 0.5 mL IM within 12 hours of birth.
* **Infants/Children post-exposure (percutaneous or permucosal):** 0.06 mL/kg IM as a single dose, as soon as possible, preferably within 12 hours of exposure.
*Dosing is weight-based for exposure prophylaxis.*
## Dose Adjustments
No specific dose adjustments are routinely required for hepatic or renal impairment.
## Contraindications
* Severe allergic reaction to human immunoglobulin preparations or any component of the product.
* IgA deficiency with antibodies against IgA (risk of anaphylactic reaction).
## Adverse Effects
Common: Pain, redness, swelling at injection site. Less common: Headache, fever, rash, nausea, vomiting, diarrhea, chills, myalgia. Rare: Anaphylaxis, angioedema, urticaria, bronchospasm.
## Key Drug Interactions
* **Live virus vaccines:** Defer administration of live virus vaccines (e.g., MMR, varicella) for at least 3 months after HBIG administration, as antibodies in HBIG may interfere with the vaccine response.
* **Hepatitis B vaccine:** HBIG can be administered concurrently with the hepatitis B vaccine at a separate injection site.
## Monitoring
* Monitor for signs of allergic reaction or anaphylaxis following administration.
* Monitor HBsAg, anti-HBs, and HBV DNA levels as per clinical guidelines to assess efficacy of prophylaxis and vaccination.
## Clinical Pearls
* HBIG is most effective when administered as soon as possible after exposure.
* For post-exposure prophylaxis in unvaccinated individuals, HBIG should be administered concurrently with the first dose of the hepatitis B vaccine series.
* HBIG is derived from human plasma and carries a theoretical risk of transmitting viral infectious agents.
* IM administration is preferred. Do not administer intravenously.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols for definitive guidance.*
